Cartilage transplants used to repair damaged shoulder joints

Rush University Medical Center is the only hospital in Illinois - and one of only a few nationwide - using cartilage transplants to repair damaged shoulder joints.

"For a long time surgeons have been looking for an alternative to joint replacement that is more effective than simply cleaning out the joint arthroscopically. In cartilage restoration, we re-grow fresh tissue or use donated tissue. It's an exciting and promising new treatment for damaged joints, now including the shoulder," said Dr. Brian Cole, an orthopedic surgeon at Rush who specializes in cartilage restoration of the joints.

Conservative treatment for cartilage defects in the shoulder, as for any joint, includes physical therapy, anti-inflammatory medications, and steroid injections. If these treatments are ineffective, arthroscopy, which involves removing scar tissue and loose pieces of cartilage through a small incision, has traditionally been the alternative of choice. But arthroscopy often provides only temporary relief, since the underlying damage to the cartilage is not corrected.

In cartilage restoration of the shoulder, the injured tissue is replaced with healthy cartilage from either the patient's own body or a donor cadaver.

The procedure is intended for young, active patients. For these individuals, metal and plastic prostheses are generally not recommended because the components wear out over time, requiring a second, more complicated surgery.

At the age of 22, Brynn O'Keefe underwent what is called an autologous chondrocyte implantation, using her own knee tissue. "I know it sounds corny," O'Keefe said, "but the surgery changed my life."

Brynn had injured her left shoulder when she fell from the uneven bars in a high school gymnastics meet. Besides the stabbing pain she experienced, as well as numbness and tingling down her arm, her shoulder would dislocate several times a day. Her arm movement was so restricted that she couldn't even brush her hair.

Cole removed healthy cartilage cells from her knee, which were then grown in a specialized tissue repair laboratory at Genzyme Corporation to create millions of new cells. In a second surgery, Cole cleaned out the defective cartilage and covered the resulting hole with a patch - a piece of periosteum, the thin material that envelops bone. He then inserted the cultured cartilage cells under the patch, where they continued to multiply and integrated with the surrounding tissue.

Brynn said that she can now play baseball with her 5-year-old stepson and even do cartwheels and handstands.

In cases where more extensive damage involves both bone and cartilage, Cole employs a procedure called osteochondral allograft transplantation. In this procedure, the defect is filled in with a cylinder of healthy tissues extracted from a donor cadaver.

Cartilage transplants in the shoulder are less common than those for the knee in part because shoulder pain is more often caused by tendonitis or tears in the soft cartilage or shoulder muscles rather than by damage to the cartilage. Patients also tolerate shoulder pain better than knee pain.

"But for younger patients in severe pain, with limited movement because of cartilage injury or wear, transplants are a new and emerging option that can help them return to an active lifestyle," Cole said.

Cole has numerous years of experience in tissue repair and heads the Cartilage Restoration Center at Rush, a multidisciplinary program specializing in the restoration of articular cartilage and meniscal deficiency. He has authored numerous peer-reviewed studies on the subject and teaches the surgical techniques to physicians in the U.S. and abroad.

Rush University Medical Center's orthopedics program ranks tenth in the nation, according to U.S. News & World Report. Physicians from Rush serve as the team physicians for the Chicago Bulls and the Chicago White Sox. For more information on orthopedics at Rush, visit http://www.rush.edu/rumc/page-R11726.html or call (888) 352-RUSH.

Rush University Medical Center is an academic medical center that encompasses the more than 600 staffed-bed hospital (including Rush Children's Hospital), the Johnston R. Bowman Health Center and Rush University. Rush University, with more than 1,730 students, is home to one of the first medical schools in the Midwest, and one of the nation's top-ranked nursing colleges. Rush University also offers graduate programs in allied health and the basic sciences. Rush is noted for bringing together clinical care and research to address major health problems, including arthritis and orthopedic disorders, cancer, heart disease, mental illness, neurological disorders and diseases associated with aging.

Firstly, I cannot believe that no one has commented on this article yet. I damaged my shoulder some years ago playing football. Sinse then I've been weight training to preserve good health. It has now been about 17 years sinse the injury. In the past 2-3 years I foolishly stopped training due to work commitments. I come to train again about 6 months ago & cutting a long story short I was told by Doctors & specialists that my joint was worn away due to arthritis. I've been a fit person all of my adult life and this was a overwhelming dissapointment which was out of my control. I still refuse to accept it. However I'm now 32 and keeping fit and after seeing this information, I intend on making further inquiries. There is possible hope after all.

Just been told that I have to replace the joint in my shoulder. There is no cartilage left. I am so interested in this. I'm a very young 61. Always have been in shape...good muscles...but a bad joint. This sounds amazing. Will be contacting someone to see if this is an option for me.

Hello again,
I hope that Sue Granlich didn't write Her comment on the basis of what I wrote. I have since found out according to the Doctors I'm currently consulting that cartlidge regrowth can only be applied to the shoulder at the size of a 20 cent piece (Australian currency). Doctors or not. I tend to disagree. I've also been speaking to people who work in stem cell research. There are rumours of clinical trials on knees for cartlidge regrowth. If there is success here then theres room for improvement. Hopefully for shoulders. Best of luck Sue.
Tony G.

Cartilage regrowth is being done on young people only in the states. So,you may be a candidate. I am seeing someone who is in the teaching/research on this very issue. Didn't realize it was such a small piece being regenerated. I know they are growing it from one's own body also. Hope you can get some answers for yourself. You're to young to have this happening. (I think Mass. General and New England Baptist in Boston would be good places to check out).

Willing to be in a experimental program to try and regrow cartilage for shoulder or have a transplant done. I am 63 and was a 3 handicap on the golf course. I want to still hit it long and far and will do what it takes. I live in Buffalo,NY. Email me if you need someone.

I'm 58 years old and have been a boxer and weightlifter. I still work out even though I have no cartilage left in my shoulders. I heard about this years ago when they were doing this procedure in Sweden and was wondering when the U.S. was going to get into the 20th century. I am definately going to look into this, it would be nice to be able to work out without pain for a change.....

I am 62 year old male that has had a liftime of exercise and bodybuilding. I still work out 5 days a week. A year ago I was told I needed immediate shoulder replacement. I sought out other opinions and the current surgeon I am going to is treating with cordisone. I have read on cartilage replacement being done in Europe. Has anyone had success. My intentions are to not give in to surgery. I am active and indend to stay that way. Any input would be appreciated.

I am 47 years old and active as a firefighter, I ride motocross, lift wieghts , mountain bike etc. all of wich cause pain. I was told after an MRI that I have no cartilage left in my shoulder. I am considering all options including replacement. Any input would be appreciated. Thanks

I am 25 years old and have seen some of the best doctors there are in Nashville TN. The doctor is a close family friend and he has examined my shoulders many times. I have had MRI's done, X-rays, physical therapy, anti-inflammatory medicine. NOTHING WORKS. I am pretty sure there is absolutely no cartilage in my shoulders and probably in others parts of my body. I am very athletic and grew up playing numerous sports. My left shoulder/arm is constantly numb, tingling sensation always, sharp pains here and there. It is probably one of the most annoying constant problems I have ever dealt with. This has been going on for about 10 years and I am finally to the point where I can not stand it. I have recently started to run a lot and it obviously irritates my shoulders beyond belief. If you need a young, very in shape individual I am your girl. I would do just about anything to stop this. I am thinking and looking into surgery in nashville but I do not want a temporary fix, I just want it fixed.

I am 52 years old and live in New Jersey. I dislocated my right shoulder 3 times between the ages of 18 and 24. I saw 3 different Orthopedics and all suggested only therapy. I saw a new orthopedic 3 days ago because I was in severe pain and couldn't lift my arm up to my head. He told me I have severs arthritis and no more cartilage left in my shoulder joint. He mentioned therapy and possible shoulder replacement. I love working out and playing sports but I would love just getting a good night sleep without having to use my good arm to move or adjust my bad arm after sleeping on the wrong side of my body. I would welcome the chance to try to regrow the cartilage in my shoulder. Does anyone know of any Orthopedic groups or specialist around the New Jersey, New York or Pennsylvania areas who specialize in these procedures. I wish everyone the best of luck in fixing what ails them.

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